Treatment of Type 1 Diabetes Flashcards
(35 cards)
what are the main aims of T1DM therapy?
prevent hyperglycaemia
avoid hypoglycaemia
reduce chronic complications (micro, macro, DKA, psychological)
how much insulin is secreted at a low basal rate?
accounts for 50% of insulin produced
as well as basally, when else is insulin released?
post prandial insulin released in response to post meal glucose
what types of insulin are available?
rapid acting analogue short acting intermediate acting long acting rapid acting analogue-intermediate mixture short acting - intermediate mixture
what is tge basal bolus regimen of insulin delivery?
attempts to mimic normal insulin
give bolus of rapid acting insulin after meals according to intake
constant basal insulin level from long acting insulin
what is the twice daily insulin regimen?
less flexible than basal bolus
one dose in the morning and one at night
once daily regimen?
one dose at night to carry through into next day
glucose spikes at every meal
initial pharmacological approach to treating T1DM?
most should be treated with MDI (3-4 injections per day) or CSII
education in how to match prandial insulin dose to carb intake and anticipated activity
most should use insulin analogues to reduce hypoglycaemia risk
how do you calculate amount of insulin to give at the start?
0.3 units per Kg body weight divide it around 50% prandial and 50% basal E.g: if total = 18 units - lantus = 9 units before bed - prandial = 3 units before each meal
how is insulin adjusted?
target = 3.9-7.2 (4-7) mmol/l pre meal target = <10 mol/l 1-2 hrs after beginning of meal
how many T1DM patients needs twice daily long acting insulin?
50-80%
what is advanced carbohydrate counting?
synchronizing the amount of insulin taken to the amount of carbohydrate consumed
who is advanced carbohydrate counting suitbale for?
those on multiple daily infections (MDI)
for people on continuous subcutaneous insulin infusion (SCII) pumps
what are the components of advanced carb counting?
insulin to carb ratio (ICR) - e.g 1 unit per 10g
insulin sensitivity factor (ISF) also known as correction factor (CF)
how can carbohydrate amount in food be estimated?
food measurement visual cues food composition tables food labels websites other technologies
what is an insulin pump?
medical device that gives continuous administration of short acting insulin subcutaneously
can deliver background basal insulin and deliver manually activated bolus insulin to cover meals
how can you evealuate metabolic control?
home blood glucose monitoring
home blood ketone monitoring
glycated haemoglobin (HbA1c)
continuous glucose monitor (mainly for people who live alone)
what are the limitations of home glucose monitoring?
fingerprick tests only give a snapshot of any one moment
what is HbAc?
largest component of the glycated haemoglobins
increases in a predictable way in response to prevailing glucose so can be used to measure average blood sugar over a longer period (2-3 months)
how can the limitations of fingerprick testing be overcome?
continuous glucose monitoring
what is the main difference between biological and artificial insulin delivery?
pancreatic secreted directly into portal system and rapidly prevents post meal hyperglycaemia and is rapidly cleared
artificial = injected into subcutaneous tissue, peaks too slow to prevent post meal hyperglycaemia, slow clearence
what factors may effect insulin absorption/action?
pen accuracy
leakage
site of injection (can go into muscle instead of SC tissue)
possible risks at injection sites?
lipohypertrophy
important things to consider in insulin prescribing?
patients usual regimen blood glucose and ketone monitoring sepsis/acute illness steroid therapy age/lifestyle
